TDR phase (0-12wks) A commercial micronutrient-replete 825–853 kcal/d liquid formula diet (soups and shakes) will be provided (Cambridge Weight Plan) to replace usual foods, with ample fluids (2.25 L), for 12 weeks. Oral hypoglycaemic agents (OHA), antihypertensive and diuretic drugs will be withdrawn on commencement of TDR, and reintroduced (as per study protocols) if T2DM or hypertension returns. Aspirin will be continued if prescribed because of a previous MI (prior to the previous 6 months), but discontinued if prescribed solely because of T2DM. Beta-blockers prescribed for the management of angina will be continued. A soluble fibre supplement (Fybogel 2 × 3.5 g/day) will be prescribed to reduce constipation. Participants will return for review one week after commencement on the TDR and at 2 weekly intervals thereafter until the commencement of the FR stage (Fig. 1). To allow some flexibility for patients whose commitments, or life events, prevent achievement of 15 kg at 12 weeks, or if individuals wish to achieve more weight loss, the TDR phase may continue up to 20 weeks. If BMI falls below 23 kg/m2 during the TDR phase, participants will be moved forward to the FR and weight loss maintenance phases. Food reintroduction phase (weeks 12–18) The FR phase includes a stepped transition to a foodbased diet based on the “Eatwell” guidelines [24] while reducing TDR. To allow flexibility for participants whose confidence varies, the FR phase can be varied between protocol-defined limits of 2–8 weeks before switching to full food-based weight loss maintenance. Participants will monitor weight on a weekly basis and compare this with caloric intake and activity levels. Participants will return for review at 2 weekly intervals throughout the FR phase. Weight loss maintenance phase.
Weight loss maintenance phase (weeks 19–104) Participants will be advised to follow a food based diet and will be provided with an individually tailored energy